Unshackling the Recent Mental Health Care Bill 2016

A few days ago, there was much rejoicing and celebrating in the mental health community. The Rajya Sabha on Monday unanimously passed the Mental Health Care Bill 2016, which seeks to provide better healthcare to people with mental illness and safeguard their rights. One of it’s salient features was giving a person the right to select a representative who would speak for the person if she or he gets diagnosed with a mental illness. Another was creating an advance directive on the mode of care a person would like, for example, if he or she has a manic or psychotic state, how would they like to be treated, should they require treatment or hospitalisation.

Said Union Health Minister, JP Nadda, while introducing the bill about the representative a person could select: “This person would be a nominative representative, who has a similar cultural background as the patient and is aware of his likes and dislikes.” He went on to say that the bill was formulated after lengthy discussions with the various stakeholders like academia, experts and political establishment and that the bill focuses on community based treatment.

Hmmm. While Facebook and Twitter went into a frenzy of sharing, and many people were rejoicing, and indeed, some things are cause for celebration, perhaps just that the government woke up and even considered mental healthcare, long neglected, and this bill was long overdue, taking more than two years of discussion and deliberation.

However, if we consider the sleeping politicians and the empty chairs at Parliament (see graphic below), does a unanimous vote mean anything? Shouldn’t mental healthcare need the same focus as healthcare? And in a country where the increasingly saffronized government keeps lauding the AYUSH department, shouldn’t Yoga and Ayurveda and Unani also be integrated into the mental healthcare space? Or is Big Pharma watching and the politics of power always at play?

Let’s examine a few improvements first

M V Rajeev Gowda of the Congress said that of the many many good things about this bill, one of the most important ones is the fact that it decriminalises suicide. He went on to say: “When a person attempts to take his or her own life, that person is crying for help, that person is not someone who should be treated as a criminal and thrown behind bars. We need to reach out and find a way to overcome the problems that have caused that kind of action.”

The Mental Health Care Bill 2013 says that any person who attempts to commit suicide shall be presumed, unless proved otherwise, to be suffering from mental illness at the time of attempting suicide and shall not be liable to punishment under section 309 of Indian Penal Code (IPC). Until now, a person who attempts to commit suicide is charged under section 309 of IPC as it is considered to be an offence. The bill also bans the use of electric shock therapy for treating children with mental illness and only permits its use on adults after they have been given anaesthesia and muscle relaxants.

Among its various objectives, the bill provides for ensuring healthcare, treatment and rehabilitation of persons with mental illness “in a manner that does not intrude on their rights and dignity.” While this bill is claiming to promote community healthcare, nothing could be farther from the truth. Several distressing questions remain.

Union Health Minister, JP Nadda, while announcing the “historic and progressive bill” said around 6-7 percent of the country’s population suffered from some kind of mental illnesses, while 1-2 percent suffer from acute mental disease. He went on to admit that there was shortage of medical staff dealing with mental health in the country and the government is trying hard to have more such specialists.

Let’s examine what is behind these words and look at the conversation in the blank spaces in these words. The Bill will encourage more mental health hospitals and institutions. Many more private and government hospitals will sprout up, with the additional funding, and the interest.

While it may be argued, that this can only be a good thing, consider this: how is electroshock therapy (long banned in most first world countries), indifferent staff, and a rampant overmedicating of patients, how are more facilities going to help? And more importantly, who will they help? The pharmaceutical companies? Kickbacks from and to medical reps? To doctors? So called concerned family members, who want to get rid of a family member, for whatever reason? More institutions will definitely not be a good thing.

Instead, there should be a reform of the existing institutions, with art therapy, music therapy, and more. And most certainly, stand alone psychiatric hospitals also called asylums or places for mad people will not help. There should be a move towards integrating psychiatry with mainstream hospitals, with Psychiatry being just another wing, like Cardiac, or ENT, etc. There should be a coherent move towards recovery, rehabilitation and engagement with community. More institutions create a divisive world, not an inclusive one. More institutions perpetuate labelling and stigma. More institutions perpetuate power being stripped from the patient.

Consent

This is another tricky word, with loopholes galore. The new bill does not state how they will determine consent. What was earlier involuntary commitment can now be called “supported admission”; advance directives can be challenged, capacity can be challenged, and “Nothing About Us Without Us”, a motto of the UNCRPD — UN CONVENTION on the RIGHTS of PERSONS with DISABILITIES — does not seem to sit well here at all. Kriti Sharma, a senior researcher at Human Rights Watch, states: “Women and girls with disabilities are dumped in institutions by their family members or police in part because the government is failing to provide appropriate support and services. And once they’re locked up, their lives are often rife with isolation, fear and abuse, with no hope of escape. Long-term warehousing of women and girls with disabilities is simply not the answer.”

In a report published in 2014, HRW reported abysmal living conditions including overcrowding, lack of hygiene, and inadequate general health facilities. The women were also found to be living under a constant risk of physical and sexual violence.

Vilas Bhailume, superintendent of a mental hospital in the western metropolis of Pune, Maharashtra, said overcrowding was a major problem. “We only have 100 toilets for more than 1,850 patients out of which only 25 are functional. The others keep getting blocked. Open defecation is the norm,” he said in the report.

I am one of the 52 women HRW interviewed, in that study conducted across six Indian cities between December 2012 and November 2014. My claim to fame being involuntary incarceration twice, once in 2007 and more recently in 2012, by family members who wanted me out of the way to facilitate my ex husband winning a messy divorce case. Since that time, my ex-husband has left India and the courts of this country, taking my four children with him. But to come back to the involuntary commitment, I cannot see how the new bill is going to change much. In a country rife with misogyny and patriarchy, if a husband or father says, she is crazy, lock her up, psychiatrists will jump up to comply.

In a shocking incident just ten days ago on 2nd August 2016 in Kolkata, a woman was forcefully admitted into a psychiatric facility, injected with sedatives and more, and while being escorted to an asylum at 11.30 PM, was intimidated and subjected to violence, including the fingering of her vagina. Her husband had joined hands with a psychiatrist to turn her into another case of ‘mental illness’. This case is not a solitary one, and unfortunately happens more and more often. The said woman has since been released, and her husband booked into jail, while women’s NGOs rallied around her, helping her to file a case.

But many other such women are not so lucky, and languish for years on end in asylums, while their husbands and fathers and family members get away scot free. And what of the families who admit their children or wives into an asylum giving a wrong address? Institutions today are full of “recovered” people just waiting to go home, but there is no home, or the address has changed or their family has left the country altogether.

Wellness, Yoga and Ayurveda, and other lifestyle choices

Psychiatric illness is caused by a mixture of genetic disposition and psychosocial conditions. An incident is often an extreme reaction to some distress in a person’s life. Most psychiatric labels like depression, bipolar disorder and more can be addressed through Yoga, better nutrition and food choices and changing the distressing condition, and moving towards less stress.

In a country like India, with the hugely celebrated AYUSH department, why is there no linkage or encouragement towards food as medicine, or using ayurvedic drugs like brahmi and others for alleviating stress? Exercise, weight loss, getting off social media, healing with nature; all these are proven methods of dealing with many psychiatric disorders. Why then, the excessive labelling? Why then, statements from practitioners like “You have bipolar disorder, you will be on medication for life?” Why??? Of course, there are certain mental health conditions which are serious, and may need medical intervention, drugs, and psychosurgery. But these are a very small percentage. Is the answer more sinister? Is it that Big Pharma is lurking everywhere? Is the brainwashing so effective? Does advertising work this well?

Questions abound

While the answers seem simple to me, it appears to me that those in positions of power are not willing to relinquish their authority. The men (and women) in white coats love dispensing drugs. And while it is now illegal to administer electroshock therapy to children, it is still allowed on adults, albeit with humane muscle relaxants and anaesthesia. Really? In addition, under the bill, psycho-surgery will only be allowed if the district medical board approves it.

We all know what a wonderfully corrupt country India is and how easy it may be to sway the attention of district medical boards. I hate being a cynic, but maybe this is being realistic. There are simply too many loopholes. Too many places where families and doctors will still get their way. And the patient will not get patience. And once labeled, they will be forever. And asylum does not give what it purports to give: asylum.

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